Provider Demographics
NPI:1144527748
Name:SUCKNEY, JODI LYN (LCSW, CAC III)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:LYN
Last Name:SUCKNEY
Suffix:
Gender:F
Credentials:LCSW, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 E 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1127
Mailing Address - Country:US
Mailing Address - Phone:303-355-1014
Mailing Address - Fax:303-355-0899
Practice Address - Street 1:2121 E 18TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1127
Practice Address - Country:US
Practice Address - Phone:303-355-1014
Practice Address - Fax:303-355-0899
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5238101YA0400X
CO12891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical